Depram 25

Indications

Depram serves as a therapeutic solution for:

• Managing depressive disorders
• Addressing nocturnal enuresis in children.

Description

Depram stands out as an original tricyclic antidepressant, belonging to the dibenzazepine group. While its precise mechanism of action remains uncertain, it is believed to enhance adrenergic synapses by impeding the uptake of norepinephrine at nerve endings. Notably, its efficacy in treating childhood enuresis is distinct from its antidepressant properties.

Pharmacology

Imipramine functions by inhibiting the reuptake of neurotransmitters such as norepinephrine and serotonin. This action increases their concentration in the synaptic cleft, thereby influencing protein kinase signaling and bringing about alterations in neurotransmission and brain physiology, ultimately alleviating depression symptoms.

Dosage & Administration

For depression:

• Initial dosage: Up to 75 mg daily, gradually increasing to 150-200 mg (up to 300 mg for hospitalized patients).
• A maximum of 150 mg may be administered as a single bedtime dose.
• For the elderly, commence with 10 mg daily, gradually escalating to 30-50 mg daily.

For nocturnal enuresis:

• Children aged 7-8 years: 25 mg
• Children aged 8-11 years: 25-50 mg
• Children over 11 years: 50-75 mg at bedtime; maximum

Treatment duration (including gradual tapering): 3 months with full physical assessments prior to further continuation.

Interactions

Imipramine’s effects may be potentiated by methylphenidate. Caution is advised to mitigate interactions with alcohol and monoamine oxidase (MAO) inhibitors, which could precipitate dangerously high blood pressure. Additionally, its anticholinergic effects may be additive with other medications of similar nature.

Contraindications

Imipramine is contraindicated when used concurrently with or within 14 days of MAO inhibitors. It is also contraindicated in patients with severe hepatic or renal impairment, history of blood dyscrasias, hypersensitivity to the drug or tricyclic antidepressants, acute myocardial infarction, convulsive disorders, or glaucoma.

Side Effects

Common side effects include dry mouth, constipation, urinary retention, increased heart rate, sedation, irritability, dizziness, and decreased coordination. However, severe side effects such as cardiovascular events, neurological manifestations, and gastrointestinal disturbances have been reported in a minority of cases.

Pregnancy & Lactation

Imipramine falls under pregnancy category D with limited data suggesting excretion in human breast milk, posing potential risks to the fetus.

Precautions & Warnings

Caution is advised, particularly in the elderly and individuals with benign prostatic hypertrophy, urinary retention, or glaucoma. Depram should be used cautiously with other central nervous system depressants, and close monitoring is recommended, especially in those with cardiovascular disease.

Overdose Effects

Children are particularly susceptible to acute overdosage, which can be severe and potentially fatal.

Therapeutic Class

Depram belongs to the therapeutic class of tricyclic and related antidepressant drugs.

Storage Conditions

Store below 30°C, away from light and moisture, and out of reach of children.